Helping Unattached Patients

The Situation 

According to Health Canada, Primary Health Care is key to maintaining and improving Canadians' health, and to the quality and sustainability of the health care system. Across Canada over 95% of people say that they have access to or are under the care of a primary care provider (family doctor, nurse practitioner or a primary care team). On the other hand according the the Health Council of Canada in 2008 fully 25% of Canadians felt that it was too difficult to see their physicians and many felt that this access was a key reason why they visited the hospital emergency department. In its November 2010 report the New Brunswick Primary Care Advisory Committee (PCAC)  identified that 93% of New Brunswickers had access to a primary care provider (usually a GP). In 2011, the New Brunswick Health Council (NBHC) surveyed New Brunswick residents and found that while 93 per cent of citizens have a family doctor, only 30 per cent can get an appointment on the same or next day. This meant that up to  60,000 New Brunswick citizens may not have had ready and continuous access to primary care. ( walk in clinics and even emergency departments can provide primary care but do not support the continuity that is the hallmark of effective primary healthcare). This is in light of the fact that the province actually has more physicians per 100,000 people than the Canadian average ( 113 vs. 106).   While it was impossible to accurately measure the extent of this issue everyone concerned agreed that it needed to be addressed.  The PCAC  further stated that young people and especially those with young families seem to have the hardest time to find a doctor. Since the recommended portal to the health system takes place in primary care the Committee stated that it is important that every New Brunswicker that wants one should have access to a primary care provider. 

The Problem 

Several regions within the province had been making significant efforts to identify and then to match people who did not have a family healthcare provider.  The usual process was to capture some information on the person and their families over the phone and to store that in an electronic record so that they could be contacted when providers were ready to take on new patients. Several thousand of these records were created from 2006 until 2012.  Unfortunately this information was not completely accurate, was not standardized across regions, and only covered regions that supported 60-70% of the people in the province. Many rural communities did not have access to the lists and therefore the province and the health regions had no way of knowing how many unattached patients resided in these areas. 

The Solution 

 In 2013 the Department of Health  began discussions to create a provincial registry. Working with partners across the health system the Department identified several key objectives for the program and began its implementation. Sykes Assistance Services was asked to coordinate the launch of the program and to operate the telephonic registration and back end patient matching services. To accomplish this the Patient Connect NB program team set up a one time transfer of the existing databases, created a real time link to the Province's on line registration portal and set up an integration process with the Tele-Care 811 program so that people could access immediate care and advice when needed. 

How it Works

When people visit the Provincial web site or call the Patient Connect toll free number they are invited to register for the program.  They are then asked a series of questions to support sorting of people who may have an urgent requirement to be seen.  All placement of people is performed using a first in first out approach. People are also asked about their preference for language and how far they would be prepared to travel to see a family healthcare provider. When practices have room to take new patients they contact the service and provide the program with the number of patients and the timing of the proposed onboarding process. The team then queries the list to identify potential candidates and their families and a letter is prepared inviting the patient to contact their new  provider. To ensure that the list is kept current people are encouraged to check back if they have a change in status such as a move or a new diagnosis.  Finally every four months an automated messaging system reaches out to participants to check to see if they are still looking or have any new information to share. 

Results

After the first year of operation several milestones have been met. The first and most important is that people now have a place to go when they are trying to get connected to a family practice.  In terms of statistical success the program has matched over 17000 people to a primary care provider in locations throughout the province.